MEDICARE: VITALITY CHIROPRACTIC CENTER PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008814	MI

General Provider Information

NPI Number	:	1982997516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY CHIROPRACTIC CENTER PLC

Provider Business Mailing Address
First Line	:	600 S BEACON BLVD
Second Line	:	SUITE B
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2178
Country	:	US
Telephone Number	:	616-402-3418
Fax Number	:	616-743-5945

Provider Business Practice Location Address
First Line	:	600 S BEACON BLVD
Second Line	:	SUITE B
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2178
Country	:	US
Telephone Number	:	616-402-3418
Fax Number	:	616-743-5945

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. SUSAN ISAACS
Credential	:	D.C.
Telephone Number	:	616-402-3418

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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